苯妥因钠,丙戊酸钠,卡马西平对癫痫患者智力的影响

抗癫痫药物造成认知功能的损害及损害程度至今仍无明确结果。为此，我们对４６例全身性强直一阵挛发作的癫痫患儿进行了服药前后的智力测验，并以１６例健康同龄人对照，以检测苯妥历钠，丙戊酸钠，卡马西平对智力的影响。     

丙戊酸钠对成人癫痫患者认知功能的影响

目的了解丙戊酸钠对成人癫痫患者认知功能的影响。方法采用简易精神状态评定量表,分别于治疗前及治疗6个月、1年、2年、3年对74例接受丙戊酸钠治疗的成人癫痫患者认知功能进行评价,并选同期健康体检者85例作为对照组。结果癫痫组丙戊酸钠血药浓度均在正常浓度范围。简易精神状态评定量表评分：在干预前,癫痫组11项得分均低于对照组（P〈0.01）;在干预后6个月、1年、2年、3年,癫痫组11项得分均低于对照组（P〈0.05）;癫痫组自身与治疗前比较,11项得分均增高（P〈0.05）,但随时间延长无进一步改善趋势（P〉0.05）;癫痫组治疗前后原发性和继发性癫痫患者间比较无差异（P〉0.05）。结论成人癫痫患者存在认知功能下降,丙戊酸钠具有改善癫痫患者认知功能的作用。     

抗癫痫药物对癫痫患者甲状腺激素水平影响的研究

目的 研究癫痫患者甲状腺激素水平和抗癫痫药物对其影响以及与疗效之间的关系。方法 测定已确诊的45例未服用过抗癫痫药物的癫痫患者血清甲状腺激素水平并与30例健康对照组进行比较。再经卡马西平、苯妥英钠、丙戊酸钠三种抗癫痫药物分组单药治疗3个月、6个月、年后观察甲状腺激素水平的变化及与疗效之间的关系。结果 未服用抗癫痫药物的新诊断癫痫患者游离甲状腺素（FT4）水平显著低于健康对照组,经苯妥英钠、卡马西平分别治疗3个月、6个月、1年后T4、FT4、FT3显著低于治疗前水平,TSH无显著性变化。经丙戊酸钠治疗后的不同时间段各甲状腺激素水平与治疗前比较无显著性差异（P＞0．05）。甲状腺激素水平的变化与化疗效之间似无相关性。结论 癫痫的反复发作虽未经抗癫痫药物治疗已存在FT4水平的降低。苯妥英钠、卡马西平可明显造成癫痫患者的亚临床甲状腺功能降低（T4、FT4、FT3下降）,丙戊酸钠对患者甲状腺激素水平无显著影响。甲状腺激素水平的变化与疗效之间无相关性。     

癫痫病人的认知功能与BRP的研究

报告６５名健康人，苯妥英钠，丙戊酸钠抗癫痫治疗患者（癫痫Ａ组）５４名，得理多治疗癫痫患者（癫痫Ｂ组）４２例的认知功能量表检测和ＥＲＰ检测结果，提示癫痫病人的认知功能有损害，Ｂ组认知功能受损轻于Ａ组，ＥＲＰ检测亦示癫痫患者认知功能受损。     

不同药物与脑电图放电指数对癫痫儿童认知功能的影响

目的探讨丙戊酸钠、托吡酯、脑电图放电指数对学龄期癫痫患儿认知功能的影响。方法 62例癫痫患儿按照随机数字表法分为2组。A组口服丙戊酸钠治疗,B组口服托吡酯治疗。另选择同期在我院健康体检的正常儿童36例为对照组。观察治疗前后A组和B组患儿认知功能情况。结果 A组、B组言语智商、操作智商、总智商评分明显低于对照组(P0.01)。A组治疗前后言语智商、操作智商、总智商评分比较无明显差异(P0.05)。B组治疗前后操作智商评分比较无统计学差异(P0.05),言语智商、总智商评分明显低于治疗前(P0.01)。放电指数≥0.5组患儿言语智商、操作智商、总智商评分明显低于放电指数0.5组患儿(P0.01)。结论托吡酯治疗学龄期儿童癫痫时对患儿认知功能可造成损害,而丙戊酸钠无明显影响,安全性较高。脑电图放电指数与癫痫患儿认知功能关系密切,临床在治疗癫痫时宜定期复查脑电图。     

丙戊酸钠和苯巴比妥对癫痫患儿尿β2-微球蛋白的影响

目的研究丙戊酸钠和苯巴比妥对癫痫患儿肾小管功能的影响。方法观察60例癫痫患儿，分别予丙戊酸钠及苯巴比妥单药治疗6个月，测定服药前后尿β2-微球蛋白的变化。结果丙戊酸钠组治疗前尿β2-MG为（O．27±0．04）mg／L，治疗后为（O．31±0．06）mg／L，t=2．60，P〈O．01。苯巴比妥组治疗前后相比较，差别无显著性。结论丙戊酸钠对癫痫患儿肾小管功能有一定程度的损伤。     

四种常用抗癫痫药物对认知功能影响的研究近况

长期以来,抗癫痫药物造成的认知功能损害及损害程度是癫痫治疗中的一个有争议的问题。本文针对这一问题,综述了苯妥因钠、卡马西平、丙戊酸钠及苯巴比妥四种常用的抗癫痫药物在这一领域的研究近况。     

抗癫痫药物性脑病研究进展

抗癫痫药物性脑病指在癫痫治疗过程中由抗癫痫药物诱发的与药物相关的脑病，为中枢神经系统毒性反应，严重者可致死亡。该病发生率低，临床表现呈非典型性，容易被忽略甚至误诊，及时明确诊断是争取合理治疗的关键。传统与新型抗癫痫药物所致脑病不尽相同，本文围绕不同抗癫痫药物性脑病的临床表现、脑电图改变、发病机制及治疗原则进行综述，发现其临床表现主要为神经系统受累的症状，其中丙戊酸钠脑病、托吡酯脑病、唑尼沙胺脑病、吡仑帕奈脑病以高血氨脑病最为常见，卡马西平脑病可表现为后部可逆性脑病综合征，苯妥英钠脑病可表现为小脑综合征。脑电图改变以背景活动减慢、放电波形增加为主，缺乏特异性。发病机制与药物本身的作用机制相关，其中奥卡西平与拉莫三嗪可通过阻滞钠通道发挥作用，唑尼沙胺、托吡酯、丙戊酸钠、吡仑帕奈之间相互作用引起血氨显著升高。治疗原则以抑制吸收、促进排泄和对症治疗为主，预后较好。     

丙戊酸钠对癫痫患儿血糖及血清胰岛素的影响

目的通过检测服用丙戊酸钠癫患儿血糖及血清胰岛素水平,观察丙戊酸钠对癫患儿血糖及血清胰岛素的影响。方法采用葡萄糖氧化酶法测定葡萄糖浓度,采用放射免疫分析法测定胰岛素浓度。结果丙戊酸钠治疗3个月、6个月时癫患儿的血清胰岛素、胰岛素抵抗指数较治疗前均明显增高(P<0.05),治疗3个月时和6个月时相比差异无统计学意义(P>0.05),但血糖无明显变化(P>0.05)。结论丙戊酸钠不引起癫患儿血糖明显变化,但血清胰岛素明显增加。     

丙戊酸钠联合托吡酯对部分发作性癫痫患儿的临床疗效分析

目的探讨丙戊酸钠联合托吡酯对部分发作性癫痫患儿脑电图及血清神经元特异性烯醇化酶(NSE)、同型半胱氨酸(Hcy)、神经肽Y(NPY)的影响。方法选取2017-01—2019-12南阳中心医院诊治的102例部分发作性癫痫患儿,随机分为2组。分别给予丙戊酸钠联合托吡酯治疗(联合组,53例)和丙戊酸钠治疗(单药组,49例)。对比2组治疗3个月后脑电图改善情况、血清指标及认知功能变化情况。结果治疗3个月后,联合组患儿脑电图改善率为86.79%,明显高于单药组改善率69.39%(P0.05)。治疗前2组患儿血清NSE、Hcy、NPY水平及各认知功能评分差异无统计学意义(P0.05);治疗3个月后联合组患儿血清NSE、Hcy水平明显低于单药组(P0.05),联合组血清NPY水平及视空间、注意、语言、定向、MoCA总分均显著高于单药组(P0.05)。联合组不良反应总发生率为16.98%,单药组为12.24%,差异无统计学意义(P0.05)。结论丙戊酸钠联合托吡酯治疗小儿部分发作性癫痫的效果良好,能有效降低患儿血清NSE、Hcy水平,提高血清NPY水平,改善患儿认知功能。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -